Please explain what happened as clearly as possible. Why do you believe you were discriminated against? Describe all person(s) who were involved including the name and contact information (if you have it) of the person(s) who discriminated against you. Please list names and contact information for any witnesses you may have.*

Have you filed this complaint with any other federal, state or local agency or with any federal or state court?*

Yes
No

If you answered Yes above, please check all of the following that apply...

Federal Agency
Federal Court
State Agency
State Court
Local Agency

Please provide information about a contact person at each agency or court where this complaint has been filed:

Name of the agency your complaint is against (if known)

Community/County (if known) where your incident(s) occurred.

Contact Person (if known)

Contact Phone (if known)

Support materials in this matter may be emailed to neotransitorg@neotransit.org. By hitting the submit button below, you are digitally signing this complaint. Please enter today's date in this box.*